Carolina Pereira

In settings where more than 20% of women of reproductive age are classified as underweight, the World Health Organization recommends balanced energy and protein (BEP) supplementation during pregnancy to reduce adverse birth outcomes. However, guidance on contextually acceptable and feasible supplement delivery platforms remains limited, posing critical challenges for implementation. We synthesized literature on acceptable and feasible delivery platforms for BEP supplementation (direct evidence), as well as iron and folic acid (IFA) or multiple micronutrient supplements (MMS; indirect evidence) to pregnant and breastfeeding women (PBW) to broaden the search scope. A systematic search was conducted across five databases and grey literature to identify studies that addressed the acceptability and feasibility of BEP supplement delivery platforms in low- and middle-income countries (LMICs), at facility and community levels. We identified 48 studies conducted in LMICs: 22 specifically evaluated BEP supplement delivery, while 26 evaluated IFA or MMS. In the direct evidence, home delivery (11/22) was the most frequently mentioned delivery platforms of BEP supplements followed by community-level feeding centers (provided cooked meals or take-home rations) anchored by frontline community health workers (8/22 studies) and antenatal care (ANC) at health facilities (6/22; some studies assessed multiple delivery platforms). Only four studies assessed preferred BEP delivery platforms, and PBW favored home over facility-based delivery. Authors attributed this preference to the comprehensive nutrition education and behavior change communication (BCC) provided during home delivery. Indirect evidence showed that enhancing delivery of IFA or MMS at health facilities (not specific) through strategies such as BCC and home visits may improve supplement compliance. Overall, limited evidence exists regarding market-based approaches for delivering any of these interventions. Based on existing evidence, scale-up delivery of BEP supplementation through ANC at health centers, enhanced by community health workers may be feasible in reaching PBW, especially when combined with BCC.

INTRODUCTION: Given the rising rates of overweight and obesity, a growing number of individuals are seeking guidance from nutrition practitioners. This study aimed to assess adherence to nutrition intervention (Mediter-ranean Diet, MD) and its association with adiposity.METHODS: We conducted this observational study at Hospital CUF Tejo with a sample of 53 patients with overweight and obesity regularly attending nutrition appointments. Participants completed a structured online questionnaire, and adherence to the MD was assessed through the PREDIMED questionnaire (low ? 5; mod-erate 6–9; high ?10). The number of appointments attended, follow-up duration, anthropometric and body composition data were extracted from clinical records.RESULTS: Participants attended, on average, 3 nutrition consultations and had a moderate adherence to the MD. Weight, BMI and waist circumference significantly decreased after nutritional counselling, with a maintenance of weight and BMI 1 year and 10 months post-treatment. Age was positively and significantly associated with MD adherence (? = 0.047; 95% CI: 0.001;0.094). Male sex was associated with higher weight (? = 13.105; 95% CI: 7.663;18.547) and waist circumference (? = 6.695; 95% CI: 2.106;11.284) at the last nutrition appointment. Physical activity was negatively associated with waist circumference at the last appointment (? = -4.342; 95% CI: -8.648;-0.037). No association was observed between MD adherence and adiposity-related markers at the last nutrition consultation.CONCLUSION: Tailored nutritional counselling provided by a nutrition professional in patients with overweight and obesity results in moderate adherence to the intervention and a reduction of adiposity-related markers.

Background/Objectives: Antenatal multiple micronutrient supplementation (MMS) improves birth outcomes more effectively than iron and folic acid (IFA) supplementation alone. However, the acceptability of MMS among pregnant individuals, a critical factor for adherence and program success, remains poorly defined and inconsistently assessed. This narrative review proposes a comprehensive definition of “acceptability” in the context of nutritional supplementation and evaluates the evidence on the acceptability of MMS compared to IFA in low- and middle-income countries (LMICs). Methods: We conducted a systematic literature search across Embase, Medline, and Scopus to identify studies (including grey literature) reporting on acceptability-related outcomes for MMS versus IFA among pregnant individuals. Studies exploring dimensions such as organoleptic properties, ease of consumption, side effects, cultural appropriateness, and socioeconomic factors were included. Results: Out of 1056 screened studies, five informed a novel multi-dimensional definition of acceptability. Six studies assessed acceptability-related characteristics. MMS was generally accepted across most organoleptic domains. Most studies reported fewer or comparable adverse side effects for MMS as compared to IFA. Studies consistently reported more perceived benefits for MMS than IFA. Facilitating factors included trust in health professionals, free provision, and family support. Barriers included poor taste or smell, fear of side effects, misconceptions, cost, and lack of family support. Conclusions: Antenatal MMS is widely acceptable in LMICs. Addressing socio-cultural, sensory, and socioeconomic factors is essential to increase uptake and adherence. This review provides a clear, standardized definition of acceptability to guide future research and inform effective program design.